Provider Demographics
NPI:1326696675
Name:MWAMBA, CAROLLYN LWANGA
Entity Type:Individual
Prefix:
First Name:CAROLLYN
Middle Name:LWANGA
Last Name:MWAMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 WILLOW PASS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2611
Mailing Address - Country:US
Mailing Address - Phone:408-380-9052
Mailing Address - Fax:
Practice Address - Street 1:1910 OLYMPIC BLVD STE 145&150
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5096
Practice Address - Country:US
Practice Address - Phone:925-344-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician